TAVI for Pure Non-calcified Aortic Regurgitation Using a Self-Expandable Transcatheter Heart Valve.

Yvonne Schneeberger,Dirk Westermann,Andreas Schaefer,Oliver D Bhadra,Niklas Schofer,Moritz Seiffert,Lenard Conradi,Simon Pecha,Hermann Reichenspurner,Stefan Blankenberg

doi:10.3389/fcvm.2021.743579

Abstract

Objectives: Transcatheter aortic valve implantation (TAVI) is routinely performed in patients with severe aortic stenosis (AS). For patients with pure non-calcified aortic regurgitation (AR) who are not suitable for open heart surgery no clear recommendations exist and use of TAVI has been largely off-label. We herein report a series of patients treated with the self-expandable AcurateNeo and Neo2 (Boston Scientific Co., Marlborough, MS, USA) transcatheter heart valve (THV) for pure AR.Methods: Between 05/2017 and 03/2021, 9 patients (88.8% female, 74.4 ± 7.1 years, logEuroSCORE II 5.5 ± 3.6%, STS PROM 6.2 ± 3.0%) received transfemoral (TF) TAVI for pure non-calcified AR following an adjusted valve sizing algorithm. Data were retrospectively analyzed according to updated Valve Academic Research Consortium (VARC-2) definitions.Results: Device success was 100%. Early safety was 77.7% (7/10), due to two (22.2%) cases of acute kidney injury. Thirty-day mortality was 0%, in seven (77.7%) patients no or trace paravalvular leakage (PVL) was seen and mild PVL in two (22.2%) patients at 30-day follow-up. No permanent pacemaker (PPM) was required during 30-day follow-up.Conclusion: In this series of selected patients using the Acurate neo THV for pure non-calcified AR, safety and efficacy were demonstrated. Thirty-day mortality as well as PPM implantation and PVL rates showed excellent results in this high-risk patient cohort. These results will have to be confirmed in larger patient cohorts.

Highlights

Transcatheter aortic valve implantation (TAVI) is routinely performed in patients with severe aortic stenosis (AS) at intermediate or high risk for surgical aortic valve replacement (SAVR), when anatomical conditions for an interventional approach are adequate [1,2,3]
While extension of TAVI to low risk patients remains controversial, mainly due to a higher risk of postprocedural permanent pacemaker (PPM) implantation, residual paravalvular leakage (PVL) and lack of long-term durability data as TAVI for Aortic Regurgitation shown in registry analyses [6,7,8], evolution of transcatheter heart valves (THV) and corresponding delivery systems is continuing
Pure Aortic regurgitation (AR) is considered a contraindication for TAVI, since absence of aortic valve calcification can lead to insufficient anchoring of the stent frame with possible consecutive valve embolization or relevant PVL [9]

Summary

Introduction

Transcatheter aortic valve implantation (TAVI) is routinely performed in patients with severe aortic stenosis (AS) at intermediate or high risk for surgical aortic valve replacement (SAVR), when anatomical conditions for an interventional approach are adequate [1,2,3]. Pure AR is considered a contraindication for TAVI, since absence of aortic valve calcification can lead to insufficient anchoring of the stent frame with possible consecutive valve embolization or relevant PVL [9]. Since particular design features of the Acurate neo THV (distal stabilization arches and upper/lower stent crown inner/outer pericardium skirts) have the potential to protect against valve embolization and residual PVL in non-calcified aortic valves it has become our default THV for treatment of pure AR in patients with a prohibitive risk for SAVR. We present our experience with this THV platform for treatment of pure AR with a special emphasis on preprocedural planning and intraprocedural considerations

Objectives

Methods

Conclusion